Abstract P3051: Are Black Hypertensive Patients Receiving Guideline-Recommended Medications?

Abstract

Objective: Examine the prevalence of black hypertensive patients receiving guideline-recommended medication therapy for treating hypertension, either thiazide diuretics or calcium channel blocking agents (CCBs), alone or a component in single pill combination. Study design: Using 2011 and 2015 National Ambulatory Medical Care Survey data, we identified adult patient visits to non-federally employed office-based physicians, with a diagnosis of hypertension or when hypertension was the reason for the visit. Population Studied: 2,454 adult hypertensive patient visits in 2011 (93.3 million weighted national estimates) and 2,648 in 2015 (141.9 million weighted national estimates). Principal Findings: Between 2011 and 2015, monotherapy prevalence was unchanged for non-Hispanic-blacks at 49%; non-Hispanic white monotherapy prevalence increased from 54% to 60%. However, in nearly 70% of visits, in both 2011 and 2015, blacks were prescribed an antihypertensive medication other than guideline recommended CCB or thiazide. The prevalence of CCB prescribing and thiazide diuretics precribing among blacks were both less than 20%. There is no difference between white patients and black patients in their shares of CCBs, thiazides and other monotherapy prescriptions in either year (Wald Chi-Square test p >.10). Conclusions: The majority of adult hypertensive patients are on monotherapy; black patients on monotherapy are not prescribed guideline recommended medication therapies, either CCB or thiazide diuretics. Hypertensive patients are getting similar pharmacological treatment across racial groups, though the guideline recommends are different for black patients. Implications for Policy or Practice: Black patients who are prescribed monotherapy as initial treatment and are not receiving guideline recommended medications nearly 69% of the time suggests that there are significant opportunities for improvement. Adoption of the 2017 ACC/AHA Guideline for High BP in Adults recommendation to lower the threshold for hypertension control from <140/<90 to <130/<80 mm is likely to have a greater impact on African Americans, compared to other populations and the focus on risk assessment will mean that more will receive treatment at a younger age.